Savings Summary
We're committed to making affordable dental services available to all of our patients. No exceptions. Make the move to UTrust Dental Plan. You'll see and feel the difference!
| ADA Code | Procedure Description | Member Pays* |
|---|---|---|
| DIAGNOSTIC & PREVENTATIVE | ||
| D0120 | Periodic Oral Evaluation | No Charge |
| D0150 | Comprehensive Oral Evaluation | No Charge |
| D0210 | Full Mouth X-Rays | No Charge |
| D0272 | Bitewings - 2 Images | No Charge |
| D0274 | Bitewings - 4 Images | No Charge |
| D0330 | Panoramic X-Rays | No Charge |
| D0140 | Limited Oral Evaluation - Problem Focused | 20% off |
| D0220 | Periapical - First Film | 20% off |
| D1110 | Adult Cleaning | 20% off |
| D1120 | Child Cleaning | 20% off |
| D1351 | Sealant - Per Tooth | 20% off |
| D1208 | Topical Application of Fluoride | 20% off |
| RESTORATIVE | ||
| D2330 | Composite Filling - One Surface, Anterior | 20% off |
| D2331 | Composite Filling - Two Surface, Anterior | 20% off |
| D2332 | Composite Filling - Three Surface, Anterior | 20% off |
| D2391 | Composite Filling - One Surface, Posterior | 20% off |
| D2392 | Composite Filling - Two Surface, Posterior | 20% off |
| D2393 | Composite Filling - Three Surface, Posterior | 20% off |
| D2740 | Crown - Porcelain/Ceramic | 20% off |
| D2750 | Crown - Porcelain/High Noble Metal | 20% off |
| D2950 | Core Buildup | 20% off |
| SPECIALTY | ||
| D3320 | Root Canal | 20% off |
| D7210 | Surgical Extraction | 20% off |
| D7220 | Removal of Impacted Tooth | 20% off |
| D6053 | Removable Denture – Implant Supported | 20% off |
| GENERAL SERVICES | ||
| D9110 | Palliative (Emergency) Treatment | 20% off |
| D9230 | Nitrous Oxide | 20% off |
| D9940 | Occlusal Night Guard | 20% off |
*Services listed on Summary of Discounts, with the exception of Orthodontic services, are performed by your selected general dentist.
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